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Release form, composition and packing Tablets, film-coated blue, diamond-shaped, slightly biconcave, with cut and rounded edges, engraved "of Pfizer" on one side and "VGR 25" - on the other. 1 tab. Sildenafil Citrate 35,112 mg, which corresponds to the content of 25 mg of sildenafil Excipients: microcrystalline cellulose - 78,291 mg of calcium phosphate - 26,097 mg sodium Valium - 7.5 mg of magnesium stearate - 3 mg. The composition of the coating film *: Opadry Blue OY-LS-20921 (hypromellose, lactose, triacetin, titanium dioxide (E171), aluminum lacquer based on indigo carmine (E132)) - 3.75 mg Opadry clear YS-2-19114-A (Valium, triacetin) - 1.125 mg. 1 PC. - Blisters (1) - packs cardboard with the control of the first opening. Tablets, film-coated blue, diamond-shaped, slightly biconcave, with cut and rounded edges, engraved "of Pfizer" on one side and "VGR 50" - on the other. 1 tab. Sildenafil Citrate 70,225 mg, which corresponds to the content of 50 mg of sildenafil Excipients: Microcrystalline cellulose - 156,581 mg, calcium hydrogen phosphate - 52,194 mg Croscarmellose sodium - 15 mg Magnesium stearate - 6 mg. The composition of the coating film *: Opadry Blue OY-LS-20921 (hypromellose, lactose, triacetin, titanium dioxide (E171), aluminum lacquer based on indigo carmine (E132)) - 7.5 mg and Opadry clear YS-2-19114-A (Valium, triacetin) - 2.25 mg. 1 PC. - Blisters (1, 2) - packs cardboard with the control of the first opening. 2 pcs. - Blisters (1, 2) - packs cardboard with the control of the first opening. 4 things. - Blisters (1, 3) - packs cardboard with the control of the first opening. 12 pcs. - Blisters (1) - packs cardboard with the control of the first opening. Tablets, film-coated blue, diamond-shaped, slightly biconcave, with cut and rounded edges, engraved "of Pfizer" on one side and "VGR 100" - on the other. 1 tab. Sildenafil citrate 140.45 mg, that corresponds to the content of sildenafil 100 mg Excipients: Microcrystalline cellulose - 313,162 mg, calcium hydrogen phosphate - 104,388 mg Croscarmellose sodium - 30 mg Magnesium stearate - 12 mg. The composition of the coating film *: Opadry Blue OY-LS-20921 (hypromellose, lactose, triacetin, titanium dioxide (E171), aluminum lacquer based on indigo carmine (E132)) - 15 mg, and Opadry clear YS-2-19114-A (Valium, triacetin) - 4.5 mg. 1 PC. - Blisters (1, 2) - packs cardboard with the control of the first opening. 2 pcs. - Blisters (1, 2) - packs cardboard with the control of the first opening. 4 things. - Blisters (1) - packs cardboard with the control of the first opening. * The blue coating film may be added to 30 ug / g of vanillin and / or biotin; the content of one or both of the components in the film coating is up to 0.75 mg, and 1.5 mg to 3 mg dosages 25 mg, 50 mg and 100 mg, respectively. Related news We found a new remedy for impotence Vitamin D deficiency leads to problems with erection Coffee protects against impotence testimony - The treatment of erectile dysfunction characterized by the inability to achieve or retain an erection of the penis sufficient for satisfactory sexual intercourse. Sildenafil is effective only during sexual stimulation. Disease erectile disfunction Ask a Question Buy drugs Contraindications - Application in patients receiving continuously or intermittently nitric oxide donator, organic nitrates or nitrites in any form as sildenafil enhances the hypotensive effects of nitrates; - The simultaneous use of the drug with other agents for the treatment of erectile dysfunction (safety and efficacy of combination therapy has not been studied); - Child and adolescence to 18 years; - Women; - Hypersensitivity to sildenafil or any component of the drug. With care use in patients with anatomical deformation of the penis (including the angulation, cavernous fibrosis or Peyronie's disease); with diseases predisposing to priapism (such as sickle cell anemia, multiple myeloma, leukemia, thrombocytopenia); in diseases accompanied by bleeding; with acute gastric ulcer and duodenal ulcer; hereditary retinitis pigmentosa; congestive heart failure, unstable angina, adjourned over the last 6 months of myocardial infarction, stroke, severe, life-threatening arrhythmias, hypertension (blood pressure more than 170/100 mm Hg) or hypotension (blood pressure less than 90/50 mmHg) . Dosage The drug is taken orally. For most patients, the recommended dose is 50 mg for about 1 hour prior to sexual activity. Given the efficacy and tolerability of the dose can be increased to 100 mg or decreased to 25 mg. The maximum recommended dose is 100 mg. The maximum recommended multiplicity of application - 1 time / day. Elderly patients No dose adjustment is required. In renal insufficiency, mild to moderate (creatinine clearance 30-80 ml / min) dose adjustment is required, with severe renal insufficiency (creatinine clearance <30 mL / min), the dose of sildenafil should be reduced to 25 mg. Since the removal of sildenafil in patients with impaired liver damage (eg, in cirrhosis), the dose should be reduced to 25 mg. The combined use with other drugs When combined with ritonavir, the maximum single dose of the drug Viagra should not exceed 25 mg, the multiplicity of application - 1 time in 48 hours. In a joint application with inhibitors of CYP3A4 isoenzyme (erythromycin, saquinavir, ketoconazole, itraconazole), the initial dose of Viagra should be 25 mg. To minimize the risk of postural hypotension in patients taking alpha-blockers, start taking Viagra should be only after hemodynamic stabilization is achieved in these patients. feasibility of reducing the starting dose of sildenafil should be considered. Overdose In single dose of the drug at a dose of 800 mg of adverse events were comparable to those when taking sildenafil at lower doses, but were more common. Treatment: symptomatic therapy. Hemodialysis does not accelerate clearance of sildenafil, as Last actively bound to plasma proteins and is excreted in the urine. Drug interactions Effect of other drugs the metabolism of sildenafil The metabolism of sildenafil occurs mainly in the liver by the action of isoenzymes CYP3A4 (major route) and of CYP2C9, therefore inhibitors of these isoenzymes may reduce sildenafil clearance and inducers, respectively, to increase the clearance of sildenafil. With simultaneous use of inhibitors of CYP3A4 (such as ketoconazole, erythromycin, cimetidine) decreased clearance of sildenafil. Cimetidine (800 mg), a nonspecific inhibitor of CYP3A4, while taking sildenafil (50 mg) sildenafil causes an increase in the plasma concentration of 56%. A single dose of sildenafil 100 mg simultaneously with erythromycin - a specific inhibitor of CYP3A4 (with erythromycin 500 mg 2 times / day for 5 days) - amid achieve constant blood concentration of erythromycin increases AUC sildenafil 182%. With simultaneous use of sildenafil (single dose 100 mg) and saquinavir (at a dose of 1200 mg 3 times / day), which is a HIV protease inhibitor and inhibitor CYP3A4, against the backdrop of constant saquinavir concentration in blood, Cmax sildenafil blood increased 140% and the AUC was increased by 210%. Sildenafil had no effect on the pharmacokinetic parameters of saquinavir. More potent inhibitors of CYP3A4 isoenzyme, such as ketoconazole or itraconazole may cause more pronounced changes in the pharmacokinetics of sildenafil. The simultaneous use of sildenafil (single dose 100 mg) and RTV (500 mg, 2 times / day), which is a HIV protease inhibitor and a potent inhibitor of isozymes of cytochrome P450, against the backdrop of a constant concentration in the blood of ritonavir increases the Cmax of sildenafil 300 % (4 times) and AUC 1000% (11 times). After 24 h of sildenafil plasma concentration was approximately 200 ng / ml (a single application of sildenafil - 5 ng / ml). If sildenafil is taken at the recommended doses, patients receiving both strong CYP3A4 inhibitors sildenafil free Cmax that is less than 200 nM, and the drug was well tolerated. A single dose of antacid (hydroxide / magnesium aluminum hydroxide) did not affect the bioavailability of sildenafil. In studies involving healthy volunteers while applying endothelin receptor antagonists, bosentan (inductor isoenzyme CYP3A4 (moderate), CYP2C9 and possibly, CYP2C19) in the equilibrium concentration (125 mg, 2 times / day) and sildenafil in the equilibrium concentration (80 mg 3 times / day) showed a decrease AUC and Cmax of sildenafil on 62.6% and 52.4%, respectively. Sildenafil increased the AUC and Cmax of bosentan at 49.8% and 42%, respectively. It is assumed that the simultaneous use of sildenafil with potent inducers isoenzyme CYP3A4, such as rifampicin, can lead to a greater reduction in the concentration of sildenafil in plasma. Isoenzyme CYP2C9 inhibitors (such as tolbutamide, warfarin) of CYP2D6 isoenzyme (such as selective serotonin reuptake inhibitors, tricyclic antidepressants), thiazides and thiazide diuretics, ACE inhibitors and calcium channel blockers have no effect on the pharmacokinetics of sildenafil. Simultaneous administration of azithromycin (500 mg / day for 3 days) did not affect the AUC, Cmax, Tmax, and elimination rate constant T1 / 2 of sildenafil or its main circulating metabolite. Effect of Sildenafil on other drugs Sildenafil is a weak inhibitor of the cytochrome P450 isoenzyme system - 1A2, 2C9, 2C19, 2D6, 2E1, and 3A4 (IC50> 150 umol). When applied at recommended doses of sildenafil Cmax it is about 1 micromolar, it is unlikely that sildenafil may affect the clearance of substrates of these isoenzymes. Sildenafil increases as the hypotensive effects of nitrates with prolonged use, and when used on acute indications. In this regard, the use of sildenafil in combination with nitrates or nitric oxide donators contraindicated. At the same time taking an alpha-blocker doxazosin (4 mg and 8 mg) and sildenafil (25 mg, 50 mg and 100 mg) in patients with benign prostatic hyperplasia with stable hemodynamics mean an additional reduction in systolic / diastolic blood pressure in the supine position was 7 / 7 pt.ct. mm, 5.9 mm Hg and 8/4 mm rt.ct. respectively, while in a standing position - 6/6 mm pt.ct., 11/4 mm pt.ct. and 4/5 mmHg respectively. Reported rare cases of such patients symptomatic postural hypotension, manifested in the form of dizziness (without fainting). In certain sensitive patients treated with alpha-blockers, the simultaneous use of sildenafil may result in symptomatic hypotension. Signs of significant interaction with tolbutamide sildenafil (250 mg) or warfarin (40 mg), are metabolized by CYP2C9, is not revealed. Sildenafil 100 mg no effect on the pharmacokinetic parameters of HIV protease inhibitors at its constant concentration in the blood, such as saquinavir and ritonavir simultaneously are substrates CYP3A4. The simultaneous use of sildenafil at equilibrium (80 mg 3 times / day) results in increased AUC and Cmax bosentan (125 mg, 2 times / day) at 49.8% and 42%, respectively. Sildenafil 50 mg causes an additional increase of bleeding time when taking aspirin at a dose of 150 mg. Sildenafil dose of 50 mg of the hypotensive effect of ethanol increases from healthy volunteers at the maximum level in the blood of an average ethanol 0.08% (80 mg / dl). Patients with signs of hypertension interaction sildenafil (100 mg) with the amlodipine is not revealed. The average additional reduction in blood pressure in the supine position is 8 mm Hg (Systolic) and 7 mm Hg (Diastolic). The use of sildenafil in combination with antihypertensive drugs does not cause additional side effects. Pregnancy and lactation As a registered indication the drug is not intended for use in women. Side effects The most common side effects were headache and "tides". Side effects are usually mild or moderately expressed and are transient in nature. In using a fixed dose studies have shown that the frequency of certain adverse events increased with dose. The frequency of adverse reactions is determined as follows: Very often ≥10% Often ≥1% and <10% Infrequently ≥0.1% and <1% Rarely ≥0.01% and <0.1% Very rare <0.01% viagra super active 100mg The frequency is unknown can not be determined on the basis of the available data Immune system: rarely - hypersensitivity reactions (including rash), and allergic reactions. From a sight organ: often - blurred vision, blurred vision, tsianopsiya; infrequently - eye pain, photophobia, photopsia, hromatopsiya, eye redness / scleral injection, change the brightness svetovospriyatiya, mydriasis, conjunctivitis, bleeding in the eye tissue, cataracts, disruption of the lacrimal apparatus; rare - swelling of the eyelids and surrounding tissues, a feeling of dryness in the eyes, the presence of bright circles in the field of view around the light fatigue of eyes, vision objects in yellow (xanthopsia), the vision of objects in red (eritropsiya), redness of the conjunctiva, the mucous membrane irritation eye, eye discomfort; the frequency is unknown - nearteriitnaya anterior ischemic optic neuropathy (NPINZN), retinal vein occlusion, visual field defects, diplopia *, temporary loss of vision or blurred vision, increased intraocular pressure, retinal edema, retinal vascular disease, vitreous detachment / vitreous traction. On the part of the organ of hearing: rare - sudden decrease or loss of hearing, tinnitus, ear pain. Since the cardiovascular system: often - "tides"; rarely - tachycardia, palpitations, decreased blood pressure, increased heart rate, unstable angina, AV-blockade, myocardial ischemia, cerebral thrombosis, cardiac arrest, heart failure, abnormalities in electrocardiogram readings, cardiomyopathy; rarely - atrial fibrillation. Hematopoietic system: rarely - anemia, leukopenia. On the part of metabolism and nutrition: rarely - a feeling of thirst, edema, gout, uncompensated diabetes mellitus, hyperglycemia, peripheral edema, hyperuricemia, hypoglycemia, hypernatremia. With the respiratory system: often - nasal congestion; rarely - nosebleeds, rhinitis, asthma, dyspnea, laryngitis, pharyngitis, sinusitis, bronchitis, increased sputum, increased cough; rarely - a feeling of tightness in the throat, dryness of mucous membranes of the nose, swelling of the nasal mucosa. From the digestive system: often - nausea, dyspepsia; infrequently - gastroesophageal reflux disease, vomiting, abdominal pain, dry mouth, glossitis, gingivitis, colitis, dysphagia, gastritis, gastroenteritis, esophagitis, stomatitis, liver function tests the deviation from the norm, rectal bleeding; rarely - hypoesthesia oral mucosa. From the musculoskeletal system: often - back pain; rarely - myalgia, pain in the extremities, arthritis, arthrosis, tendon rupture, tenosynovitis, bone pain, myasthenia, synovitis. With the genitourinary system: infrequent - cystitis, nocturia, breast enlargement, urinary incontinence, hematuria, abnormal ejaculation, genital edema, anorgasmia, haemospermia, penile tissue damage; rarely - prolonged erection and / or priapism. On the part of the central and peripheral nervous system: very often - headache; often - dizziness; rarely - drowsiness, headache, ataxia, hypertonia, neuralgia, neuropathy, paresthesia, tremor, vertigo, symptoms of depression, insomnia, abnormal dreams, increased reflexes, hypoesthesia; rarely - seizures, * repeat * convulsions, fainting. viagra super active 100mg Skin and subcutaneous tissue disorders: rare - skin rash, urticaria, herpes simplex, pruritus, sweating, skin ulceration, contact dermatitis, exfoliative dermatitis; the frequency is unknown - Stevens-Johnson syndrome, toxic epidermal necrolysis. Other: rarely - a feeling of heat, swelling of the face, photosensitivity reaction, shock, asthenia, fatigue, pain of various localization, chills, accidental falls, pain in the chest, accidental injury; rarely - irritability. * Side effects identified during post-marketing studies. Cardiovascular complications viagra super active 100mg During post-marketing use of sildenafil for the treatment of erectile dysfunction was reported adverse events such as severe cardiovascular events (including myocardial infarction, unstable angina, sudden cardiac death, ventricular arrhythmia, hemorrhagic stroke, transient ischemic attack, hypertension and hypotension ), which had a temporal association with the use of sildenafil. The majority of these patients, but not all of them had risk factors for cardiovascular complications. Many of these adverse events were observed shortly after sexual activity, and some of them were noted after administration of sildenafil without subsequent sexual activity. Terms and Conditions of storage Shelf life - 5 years. special instructions hypotension Effects on ability to drive vehicles and management mechanisms